Form DOC02-418 "Infants at Work Liability Waiver and Release" - Washington

What Is Form DOC02-418?

This is a legal form that was released by the Washington State Department of Corrections - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2019;
  • The latest edition provided by the Washington State Department of Corrections;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form DOC02-418 by clicking the link below or browse more documents and templates provided by the Washington State Department of Corrections.

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Download Form DOC02-418 "Infants at Work Liability Waiver and Release" - Washington

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INFANTS AT WORK
LIABILITY WAIVER AND RELEASE
This waiver and release affects my legal rights and by signing this form, I agree to the
following terms and conditions:
I agree that if I participate in the Infants at Work program, I do so at my infant’s and my own
1.
risk. I certify that my infant has no current health concerns or medical issues that would be
aggravated by being in the work environment. I acknowledge that bringing my infant into a
work environment may increase the risk of my infant contracting an illness or medical
condition.
I voluntarily assume all risk of injury or the contraction of any illness or medical condition to
2.
myself or my infant. I also voluntarily assume all risk of any damage, loss, or theft of any
personal property that may result from participation in the program.
I agree on behalf of myself and my infant and your personal representatives, heirs, executors,
3.
administrators, agents, and assigns to release, discharge, and hold harmless the Department,
state of Washington, and any of its agencies, officials, agents, and employees from any and all
claims, liabilities, causes of action, and demands of any kind arising out of or related to my
participation in the Infants at Work program.
I hereby waive any and all rights I may have to bring an action for damages or other remedy for
4.
injuries that may be sustained by me or my infant as a result of my participation in the Infants at
Work program, including injuries arising from (a) the Department’s negligence, (b) my use of
any Department equipment or facilities, and (c) improper or negligent maintenance of any such
Department equipment or facilities
.
I acknowledge that I have read this waiver, understand that it is a release of liability, and am
waiving any right to bring legal action to assert a claim of negligence against the Department
and the State of Washington.
Parent/legal guardian
Signature
Date
The contents of this document may be eligible for public disclosure. Social Security Numbers are considered confidential information and
will be redacted in the event of such a request. This form is governed by Executive Order 16-01, RCW 42.56, and RCW 40.14. Upon
completion, the data classification category may change.
Distribution: ORIGINAL - Human Resources
COPY - Employee
DOC 02-418 (Rev. 06/01/19)
Page 1 of 1
DOC 830.130
Data classification category 1
INFANTS AT WORK
LIABILITY WAIVER AND RELEASE
This waiver and release affects my legal rights and by signing this form, I agree to the
following terms and conditions:
I agree that if I participate in the Infants at Work program, I do so at my infant’s and my own
1.
risk. I certify that my infant has no current health concerns or medical issues that would be
aggravated by being in the work environment. I acknowledge that bringing my infant into a
work environment may increase the risk of my infant contracting an illness or medical
condition.
I voluntarily assume all risk of injury or the contraction of any illness or medical condition to
2.
myself or my infant. I also voluntarily assume all risk of any damage, loss, or theft of any
personal property that may result from participation in the program.
I agree on behalf of myself and my infant and your personal representatives, heirs, executors,
3.
administrators, agents, and assigns to release, discharge, and hold harmless the Department,
state of Washington, and any of its agencies, officials, agents, and employees from any and all
claims, liabilities, causes of action, and demands of any kind arising out of or related to my
participation in the Infants at Work program.
I hereby waive any and all rights I may have to bring an action for damages or other remedy for
4.
injuries that may be sustained by me or my infant as a result of my participation in the Infants at
Work program, including injuries arising from (a) the Department’s negligence, (b) my use of
any Department equipment or facilities, and (c) improper or negligent maintenance of any such
Department equipment or facilities
.
I acknowledge that I have read this waiver, understand that it is a release of liability, and am
waiving any right to bring legal action to assert a claim of negligence against the Department
and the State of Washington.
Parent/legal guardian
Signature
Date
The contents of this document may be eligible for public disclosure. Social Security Numbers are considered confidential information and
will be redacted in the event of such a request. This form is governed by Executive Order 16-01, RCW 42.56, and RCW 40.14. Upon
completion, the data classification category may change.
Distribution: ORIGINAL - Human Resources
COPY - Employee
DOC 02-418 (Rev. 06/01/19)
Page 1 of 1
DOC 830.130
Data classification category 1